Cross-sectional comparison of the epidemiology of DSM-5 generalized anxiety disorder across the globe

Ayelet Meron Ruscio, Lauren S. Hallion, Carmen C.W. Lim, Sergio Aguilar-Gaxiola, Ali Al-Hamzawi, Jordi Alonso, Laura Helena Andrade, Guilherme Borges, Evelyn J. Bromet, Brendan Bunting, José Miguel Caldas De Almeida, Koen Demyttenaere, Silvia Florescu, Giovanni De Girolamo, Oye Gureje, Josep Maria Haro, Yanling He, Hristo Hinkov, Chiyi Hu, Peter De JongeElie G. Karam, Sing Lee, Jean Pierre Lepine, Daphna Levinson, Zeina Mneimneh, Fernando Navarro-Mateu, José Posada-Villa, Tim Slade, Dan J. Stein, Yolanda Torres, Hidenori Uda, Bogdan Wojtyniak, Ronald C. Kessler, Somnath Chatterji, Kate M. Scott

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Importance Generalized anxiety disorder (GAD) is poorly understood compared with other anxiety disorders, and debates persist about the seriousness of this disorder. Few data exist on GAD outside a small number of affluent, industrialized nations. No population-based data exist on GAD as it is currently defined in DSM-5. OBJECTIVE To provide the first epidemiologic data on DSM-5 GAD and explore cross-national differences in its prevalence, course, correlates, and impact. DESIGN, SETTING, AND PARTICIPANTS Data come from the World Health Organization World Mental Health Survey Initiative. Cross-sectional general population surveys were carried out in 26 countries using a consistent research protocol and assessment instrument. A total of 147 261 adults from representative household samples were interviewed face-to-face in the community. The surveys were conducted between 2001 and 2012. Data analysis was performed from July 22, 2015, to December 12, 2016. MAIN OUTCOMES AND MEASURES The Composite International Diagnostic Interview was used to assess GAD along with comorbid disorders, role impairment, and help seeking. RESULTS Respondents were 147 261 adults aged 18 to 99 years. The surveys had a weighted mean response rate of 69.5%. Across surveys, DSM-5 GAD had a combined lifetime prevalence (SE) of 3.7% (0.1%), 12-month prevalence of 1.8% (0.1%), and 30-day prevalence of 0.8% (0). Prevalence estimates varied widely across countries, with lifetime prevalence highest in high-income countries (5.0% [0.1%]), lower in middle-income countries (2.8% [0.1%]), and lowest in low-income countries (1.6% [0.1%]). Generalized anxiety disorder typically begins in adulthood and persists over time, although onset is later and clinical course is more persistent in lower-income countries. Lifetime comorbidity is high (81.9% [0.7%]), particularly with mood (63.0% [0.9%]) and other anxiety (51.7% [0.9%]) disorders. Severe role impairment is common across life domains (50.6% [1.2%]), particularly in high-income countries. Treatment is sought by approximately half of affected individuals (49.2% [1.2%]), especially those with severe role impairment (59.4% [1.8%]) or comorbid disorders (55.8% [1.4%]) and those living in high-income countries (59.0% [1.3%]). CONCLUSIONS AND RELEVANCE The findings of this study show that DSM-5 GAD is more prevalent than DSM-IV GAD and is associated with substantial role impairment. The disorder is especially common and impairing in high-income countries despite a negative association between GAD and socioeconomic status within countries. These results underscore the public health significance of GAD across the globe while uncovering cross-national differences in prevalence, course, and impairment that require further investigation.

Original languageEnglish
Pages (from-to)465-475
Number of pages11
JournalJAMA Psychiatry
Volume74
Issue number5
DOIs
Publication statusPublished - May 1 2017

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Anxiety Disorders
Epidemiology
Health Surveys
Developed Countries
Social Class
Diagnostic and Statistical Manual of Mental Disorders
Population
Comorbidity
Mental Health
Anxiety
Public Health
Outcome Assessment (Health Care)
Surveys and Questionnaires
Interviews

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Ruscio, A. M., Hallion, L. S., Lim, C. C. W., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., ... Scott, K. M. (2017). Cross-sectional comparison of the epidemiology of DSM-5 generalized anxiety disorder across the globe. JAMA Psychiatry, 74(5), 465-475. https://doi.org/10.1001/jamapsychiatry.2017.0056

Cross-sectional comparison of the epidemiology of DSM-5 generalized anxiety disorder across the globe. / Ruscio, Ayelet Meron; Hallion, Lauren S.; Lim, Carmen C.W.; Aguilar-Gaxiola, Sergio; Al-Hamzawi, Ali; Alonso, Jordi; Andrade, Laura Helena; Borges, Guilherme; Bromet, Evelyn J.; Bunting, Brendan; De Almeida, José Miguel Caldas; Demyttenaere, Koen; Florescu, Silvia; De Girolamo, Giovanni; Gureje, Oye; Haro, Josep Maria; He, Yanling; Hinkov, Hristo; Hu, Chiyi; De Jonge, Peter; Karam, Elie G.; Lee, Sing; Lepine, Jean Pierre; Levinson, Daphna; Mneimneh, Zeina; Navarro-Mateu, Fernando; Posada-Villa, José; Slade, Tim; Stein, Dan J.; Torres, Yolanda; Uda, Hidenori; Wojtyniak, Bogdan; Kessler, Ronald C.; Chatterji, Somnath; Scott, Kate M.

In: JAMA Psychiatry, Vol. 74, No. 5, 01.05.2017, p. 465-475.

Research output: Contribution to journalArticle

Ruscio, AM, Hallion, LS, Lim, CCW, Aguilar-Gaxiola, S, Al-Hamzawi, A, Alonso, J, Andrade, LH, Borges, G, Bromet, EJ, Bunting, B, De Almeida, JMC, Demyttenaere, K, Florescu, S, De Girolamo, G, Gureje, O, Haro, JM, He, Y, Hinkov, H, Hu, C, De Jonge, P, Karam, EG, Lee, S, Lepine, JP, Levinson, D, Mneimneh, Z, Navarro-Mateu, F, Posada-Villa, J, Slade, T, Stein, DJ, Torres, Y, Uda, H, Wojtyniak, B, Kessler, RC, Chatterji, S & Scott, KM 2017, 'Cross-sectional comparison of the epidemiology of DSM-5 generalized anxiety disorder across the globe', JAMA Psychiatry, vol. 74, no. 5, pp. 465-475. https://doi.org/10.1001/jamapsychiatry.2017.0056
Ruscio AM, Hallion LS, Lim CCW, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J et al. Cross-sectional comparison of the epidemiology of DSM-5 generalized anxiety disorder across the globe. JAMA Psychiatry. 2017 May 1;74(5):465-475. https://doi.org/10.1001/jamapsychiatry.2017.0056
Ruscio, Ayelet Meron ; Hallion, Lauren S. ; Lim, Carmen C.W. ; Aguilar-Gaxiola, Sergio ; Al-Hamzawi, Ali ; Alonso, Jordi ; Andrade, Laura Helena ; Borges, Guilherme ; Bromet, Evelyn J. ; Bunting, Brendan ; De Almeida, José Miguel Caldas ; Demyttenaere, Koen ; Florescu, Silvia ; De Girolamo, Giovanni ; Gureje, Oye ; Haro, Josep Maria ; He, Yanling ; Hinkov, Hristo ; Hu, Chiyi ; De Jonge, Peter ; Karam, Elie G. ; Lee, Sing ; Lepine, Jean Pierre ; Levinson, Daphna ; Mneimneh, Zeina ; Navarro-Mateu, Fernando ; Posada-Villa, José ; Slade, Tim ; Stein, Dan J. ; Torres, Yolanda ; Uda, Hidenori ; Wojtyniak, Bogdan ; Kessler, Ronald C. ; Chatterji, Somnath ; Scott, Kate M. / Cross-sectional comparison of the epidemiology of DSM-5 generalized anxiety disorder across the globe. In: JAMA Psychiatry. 2017 ; Vol. 74, No. 5. pp. 465-475.
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abstract = "Importance Generalized anxiety disorder (GAD) is poorly understood compared with other anxiety disorders, and debates persist about the seriousness of this disorder. Few data exist on GAD outside a small number of affluent, industrialized nations. No population-based data exist on GAD as it is currently defined in DSM-5. OBJECTIVE To provide the first epidemiologic data on DSM-5 GAD and explore cross-national differences in its prevalence, course, correlates, and impact. DESIGN, SETTING, AND PARTICIPANTS Data come from the World Health Organization World Mental Health Survey Initiative. Cross-sectional general population surveys were carried out in 26 countries using a consistent research protocol and assessment instrument. A total of 147 261 adults from representative household samples were interviewed face-to-face in the community. The surveys were conducted between 2001 and 2012. Data analysis was performed from July 22, 2015, to December 12, 2016. MAIN OUTCOMES AND MEASURES The Composite International Diagnostic Interview was used to assess GAD along with comorbid disorders, role impairment, and help seeking. RESULTS Respondents were 147 261 adults aged 18 to 99 years. The surveys had a weighted mean response rate of 69.5{\%}. Across surveys, DSM-5 GAD had a combined lifetime prevalence (SE) of 3.7{\%} (0.1{\%}), 12-month prevalence of 1.8{\%} (0.1{\%}), and 30-day prevalence of 0.8{\%} (0). Prevalence estimates varied widely across countries, with lifetime prevalence highest in high-income countries (5.0{\%} [0.1{\%}]), lower in middle-income countries (2.8{\%} [0.1{\%}]), and lowest in low-income countries (1.6{\%} [0.1{\%}]). Generalized anxiety disorder typically begins in adulthood and persists over time, although onset is later and clinical course is more persistent in lower-income countries. Lifetime comorbidity is high (81.9{\%} [0.7{\%}]), particularly with mood (63.0{\%} [0.9{\%}]) and other anxiety (51.7{\%} [0.9{\%}]) disorders. Severe role impairment is common across life domains (50.6{\%} [1.2{\%}]), particularly in high-income countries. Treatment is sought by approximately half of affected individuals (49.2{\%} [1.2{\%}]), especially those with severe role impairment (59.4{\%} [1.8{\%}]) or comorbid disorders (55.8{\%} [1.4{\%}]) and those living in high-income countries (59.0{\%} [1.3{\%}]). CONCLUSIONS AND RELEVANCE The findings of this study show that DSM-5 GAD is more prevalent than DSM-IV GAD and is associated with substantial role impairment. The disorder is especially common and impairing in high-income countries despite a negative association between GAD and socioeconomic status within countries. These results underscore the public health significance of GAD across the globe while uncovering cross-national differences in prevalence, course, and impairment that require further investigation.",
author = "Ruscio, {Ayelet Meron} and Hallion, {Lauren S.} and Lim, {Carmen C.W.} and Sergio Aguilar-Gaxiola and Ali Al-Hamzawi and Jordi Alonso and Andrade, {Laura Helena} and Guilherme Borges and Bromet, {Evelyn J.} and Brendan Bunting and {De Almeida}, {Jos{\'e} Miguel Caldas} and Koen Demyttenaere and Silvia Florescu and {De Girolamo}, Giovanni and Oye Gureje and Haro, {Josep Maria} and Yanling He and Hristo Hinkov and Chiyi Hu and {De Jonge}, Peter and Karam, {Elie G.} and Sing Lee and Lepine, {Jean Pierre} and Daphna Levinson and Zeina Mneimneh and Fernando Navarro-Mateu and Jos{\'e} Posada-Villa and Tim Slade and Stein, {Dan J.} and Yolanda Torres and Hidenori Uda and Bogdan Wojtyniak and Kessler, {Ronald C.} and Somnath Chatterji and Scott, {Kate M.}",
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T1 - Cross-sectional comparison of the epidemiology of DSM-5 generalized anxiety disorder across the globe

AU - Ruscio, Ayelet Meron

AU - Hallion, Lauren S.

AU - Lim, Carmen C.W.

AU - Aguilar-Gaxiola, Sergio

AU - Al-Hamzawi, Ali

AU - Alonso, Jordi

AU - Andrade, Laura Helena

AU - Borges, Guilherme

AU - Bromet, Evelyn J.

AU - Bunting, Brendan

AU - De Almeida, José Miguel Caldas

AU - Demyttenaere, Koen

AU - Florescu, Silvia

AU - De Girolamo, Giovanni

AU - Gureje, Oye

AU - Haro, Josep Maria

AU - He, Yanling

AU - Hinkov, Hristo

AU - Hu, Chiyi

AU - De Jonge, Peter

AU - Karam, Elie G.

AU - Lee, Sing

AU - Lepine, Jean Pierre

AU - Levinson, Daphna

AU - Mneimneh, Zeina

AU - Navarro-Mateu, Fernando

AU - Posada-Villa, José

AU - Slade, Tim

AU - Stein, Dan J.

AU - Torres, Yolanda

AU - Uda, Hidenori

AU - Wojtyniak, Bogdan

AU - Kessler, Ronald C.

AU - Chatterji, Somnath

AU - Scott, Kate M.

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Importance Generalized anxiety disorder (GAD) is poorly understood compared with other anxiety disorders, and debates persist about the seriousness of this disorder. Few data exist on GAD outside a small number of affluent, industrialized nations. No population-based data exist on GAD as it is currently defined in DSM-5. OBJECTIVE To provide the first epidemiologic data on DSM-5 GAD and explore cross-national differences in its prevalence, course, correlates, and impact. DESIGN, SETTING, AND PARTICIPANTS Data come from the World Health Organization World Mental Health Survey Initiative. Cross-sectional general population surveys were carried out in 26 countries using a consistent research protocol and assessment instrument. A total of 147 261 adults from representative household samples were interviewed face-to-face in the community. The surveys were conducted between 2001 and 2012. Data analysis was performed from July 22, 2015, to December 12, 2016. MAIN OUTCOMES AND MEASURES The Composite International Diagnostic Interview was used to assess GAD along with comorbid disorders, role impairment, and help seeking. RESULTS Respondents were 147 261 adults aged 18 to 99 years. The surveys had a weighted mean response rate of 69.5%. Across surveys, DSM-5 GAD had a combined lifetime prevalence (SE) of 3.7% (0.1%), 12-month prevalence of 1.8% (0.1%), and 30-day prevalence of 0.8% (0). Prevalence estimates varied widely across countries, with lifetime prevalence highest in high-income countries (5.0% [0.1%]), lower in middle-income countries (2.8% [0.1%]), and lowest in low-income countries (1.6% [0.1%]). Generalized anxiety disorder typically begins in adulthood and persists over time, although onset is later and clinical course is more persistent in lower-income countries. Lifetime comorbidity is high (81.9% [0.7%]), particularly with mood (63.0% [0.9%]) and other anxiety (51.7% [0.9%]) disorders. Severe role impairment is common across life domains (50.6% [1.2%]), particularly in high-income countries. Treatment is sought by approximately half of affected individuals (49.2% [1.2%]), especially those with severe role impairment (59.4% [1.8%]) or comorbid disorders (55.8% [1.4%]) and those living in high-income countries (59.0% [1.3%]). CONCLUSIONS AND RELEVANCE The findings of this study show that DSM-5 GAD is more prevalent than DSM-IV GAD and is associated with substantial role impairment. The disorder is especially common and impairing in high-income countries despite a negative association between GAD and socioeconomic status within countries. These results underscore the public health significance of GAD across the globe while uncovering cross-national differences in prevalence, course, and impairment that require further investigation.

AB - Importance Generalized anxiety disorder (GAD) is poorly understood compared with other anxiety disorders, and debates persist about the seriousness of this disorder. Few data exist on GAD outside a small number of affluent, industrialized nations. No population-based data exist on GAD as it is currently defined in DSM-5. OBJECTIVE To provide the first epidemiologic data on DSM-5 GAD and explore cross-national differences in its prevalence, course, correlates, and impact. DESIGN, SETTING, AND PARTICIPANTS Data come from the World Health Organization World Mental Health Survey Initiative. Cross-sectional general population surveys were carried out in 26 countries using a consistent research protocol and assessment instrument. A total of 147 261 adults from representative household samples were interviewed face-to-face in the community. The surveys were conducted between 2001 and 2012. Data analysis was performed from July 22, 2015, to December 12, 2016. MAIN OUTCOMES AND MEASURES The Composite International Diagnostic Interview was used to assess GAD along with comorbid disorders, role impairment, and help seeking. RESULTS Respondents were 147 261 adults aged 18 to 99 years. The surveys had a weighted mean response rate of 69.5%. Across surveys, DSM-5 GAD had a combined lifetime prevalence (SE) of 3.7% (0.1%), 12-month prevalence of 1.8% (0.1%), and 30-day prevalence of 0.8% (0). Prevalence estimates varied widely across countries, with lifetime prevalence highest in high-income countries (5.0% [0.1%]), lower in middle-income countries (2.8% [0.1%]), and lowest in low-income countries (1.6% [0.1%]). Generalized anxiety disorder typically begins in adulthood and persists over time, although onset is later and clinical course is more persistent in lower-income countries. Lifetime comorbidity is high (81.9% [0.7%]), particularly with mood (63.0% [0.9%]) and other anxiety (51.7% [0.9%]) disorders. Severe role impairment is common across life domains (50.6% [1.2%]), particularly in high-income countries. Treatment is sought by approximately half of affected individuals (49.2% [1.2%]), especially those with severe role impairment (59.4% [1.8%]) or comorbid disorders (55.8% [1.4%]) and those living in high-income countries (59.0% [1.3%]). CONCLUSIONS AND RELEVANCE The findings of this study show that DSM-5 GAD is more prevalent than DSM-IV GAD and is associated with substantial role impairment. The disorder is especially common and impairing in high-income countries despite a negative association between GAD and socioeconomic status within countries. These results underscore the public health significance of GAD across the globe while uncovering cross-national differences in prevalence, course, and impairment that require further investigation.

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